Background: Households in sub-Saharan Africa are highly reliant on the retail sector for obtaining treatment for
malaria fevers and other illnesses. As donors and governments seek to promote the use of artemisinin combination
therapy in malaria-endemic areas through subsidized anti-malarials offered in the retail sector, understanding the
stocking and pricing decisions of retail outlets is vital.
Methods: A survey of all medicine retailers serving Bungoma East District in western Kenya was conducted three
months after the launch of the AMFm subsidy in Kenya. The survey obtained information on each anti-malarial in
stock: brand name, price, sales volume, outlet characteristics and GPS co-ordinates. These data were matched to
household-level data from the Webuye Health and Demographic Surveillance System, from which population
density and fever prevalence near each shop were determined. Regression analysis was used to identify the factors
associated with retailers’ likelihood of stocking subsidized artemether lumefantrine (AL) and the association
between price and sales for AL, quinine and sulphadoxine-pyrimethamine (SP).
Results: Ninety-seven retail outlets in the study area were surveyed; 11% of outlets stocked subsidized AL. Size of
the outlet and having a pharmacist on staff were associated with greater likelihood of stocking subsidized AL. In
the multivariable model, total volume of anti-malarial sales was associated with greater likelihood of stocking
subsidized AL and competition was important; likelihood of stocking subsidized AL was considerably higher if the
nearest neighbour stocked subsidized AL. Price was a significant predictor of sales volume for all three types of
anti-malarials but the relationship varied, with the largest price sensitivity found for SP drugs.
Conclusion: The results suggest that helping small outlets overcome the constraints to stocking subsidized AL
should be a priority. Competition between retailers and prices can play an important role in greater adoption of AL